NPIMap

Individual provider Active NPI

Philip Wisotsky, MD

  • Internal Medicine Physician
  • Waldorf, MD
National Provider Identifier
1508862509
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D18545 Issued in MD
Practice address
11350 Pembrooke SQ Ste 311
Waldorf, MD 20603-4809
Phone
(301) 870-0660
Fax
(301) 932-8310
NPI assigned
Jun 23, 2005
Reactivated
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X D18545 MD
Internal Medicine Physician 207R00000X D18545 MD Primary

Addresses

Primary practice location

11350 Pembrooke SQ Ste 311
Waldorf, MD 20603-4809

Mailing address

11350 Pembrooke SQ Ste 311
Waldorf, MD 20603-4809
Phone (301) 870-0660

Other identifiers 2

IdentifierTypeStateIssuer
960821400MedicaidMD
110167788OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100430000354 MD Practitioner - Internal MedicinePractitioner - Geriatric Medicine 0446387021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geriatric Multispecialty AssociatesGroup PAC ID 4082018767, 2 clinicians

Practice addresses (Care Compare)

11350 Pembrooke SQ
Suite 311
Waldorf, MD 20603-4809
Phone (301) 870-0660

Hospital & facility affiliations

  • Homecall Home health agency, Easton, MD, CCN 217066
  • Medstar Health Home Care Home health agency, Hyattsville, MD, CCN 217150
  • Chesapeake - Potomac Home Health Agency, Inc. Home health agency, Hughesville, MD, CCN 217138
  • Amedisys Home Health Care Home health agency, Largo, MD, CCN 217149
  • University of MD Charles Regional Medical Center Hospital, La Plata, MD, CCN 210035
  • Medstar Saint Mary'S Hospital Hospital, Leonardtown, MD, CCN 210028

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric Multispecialty Associates Internal Medicine CurrentSince Jun 14, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

11350 Pembrooke Sq
Ste 311
Waldorf, MD 20603
Phone (301) 645-7011

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBGECD/Endpoint/DBGECD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1508862509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 PEMBROOKE SQ STE 311",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034809",
            "telephone_number": "301-870-0660",
            "fax_number": "301-932-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 PEMBROOKE SQ STE 311",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034809",
            "telephone_number": "301-870-0660",
            "fax_number": "301-932-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISOTSKY",
        "first_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D18545",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D18545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "960821400",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110167788",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.